Pediatric Obsessive Compulsive Disorder (OCD) is a chronic, impairing condition that accrues significant concurrent and long-term risk to affected youth. Although a number of empirically supported treatments for OCD exist, many children and their families are either not able to adequately access these treatments or derive only partial benefit from them. Such findings highlight the importance of developing more efficacious treatment options, which have the potential to be widely accessible to youth with OCD. Recent efforts to improve existing treatments for anxiety, including OCD, have emerged from the established experimental literature on threat-related attentional bias in anxiety. This novel theory-driven treatment utilizes computer-based attention training protocols to directly but implicitly modify biased attention patterns in anxious patients in service of symptom relief. The rapidly accumulating evidence base for attention training suggests it may be a promising new intervention for anxiety; however, the extant research has been largely conducted with non-clinical anxiety samples and primarily with adult populations. Thus, we propose a developmental translation of basic findings from experimental research on cognitive biases in anxiety into a novel computer- based attention training intervention for pediatric OCD as an initial step towards demonstrating its feasibility, acceptability and preliminary efficacy. To date, no study has investigated attention training in pediatric OCD, although there are positive findings in adults and children with Social Phobia, Generalized Anxiety Disorder, and sub-clinical OCD. The proposed study will be conducted in two phases. Phase 1 will entail protocol adaptation and development in conjunction with the treatment of an open case series of six children. Phase 2 will involve a small randomized controlled trial (n = 52) that will evaluate the acceptability, feasibility and preliminary efficacy of an eight-session computerized attention modification program versus an attention control condition in reducing attention bias to threat and overall symptom severity in youth with OCD. In addition, a three-month follow-up will be included to gather initial data on durability of treatment gains. We also propose to investigate in an exploratory manner the potential relationship between attention training and changes in behavioral and electrophysiological correlates of cognitive control and affect regulation before and after treatment with AMP or ACC. Preliminary investigation of the relationship between neural indices, baseline attention bias as well as temperament-related ratings of attention control may begin to elucidate potential predictors/moderators of this novel treatment for childhood OCD. Our expectation is that feasibility and preliminary efficacy findings from this project will inform the development of a future large-scale intervention trial, which will hopefull further advance the development of innovative, personalized interventions studies consistent with NIMH Strategic Plan's Objectives (3.1). PUBLIC HEALTH RELEVANCE: Pediatric Obsessive Compulsive Disorder (OCD) is a chronic, impairing condition that absent treatment accrues significant concurrent and long-term risk to affected youth, thus presenting a substantial burden on public health. Despite a number of empirically supported treatments for OCD, many children and their families are either unable to access these treatments or derive only partial benefit from them. The aim of this application is to develop and test a novel computer-delivered intervention directed at modifying biased attention patterns in OCD in service of symptom relief, with the ultimate goal of expanding effective treatment options available to affected youth.